Stroke Treatment Stratification: Integration of Neuroprotection, Neuroregeneration and Rehabilitation Approaches. A Review

INTRODUCTION. Stroke remains one of the leading causes of mortality and disability worldwide. Despite advances in reperfusion therapy (thrombolysis and thrombectomy), a significant proportion of patients retain severe neurological deficits. Standard protocols, which do not account for the diversity of strokes, reduce treatment effectiveness, necessitating the implementation of a personalized approach. AIM. To present a review of literature data on the principles of stroke treatment stratification, as well as modern approaches to neuroprotection, neuroregeneration, and rehabilitation of patients with cerebrovascular pathology. MATERIALS AND METHODS. An analysis of 32 literature sources was conducted based on the RINTs and PubMed databases for the period 2020–2025 regarding stroke treatment stratification and precision neurology. Materials on the application of neuroimaging methods, pharmacogenetic profiling, neuromodulation, and telemedicine technologies in the acute and recovery periods of the disease were analyzed. RESULTS AND DISCUSSION. A concept of stroke treatment stratification has been proposed: the division of patients into groups depending on pathogenetic features, the time window and the prognosis of recovery. Modern strategies for neuroprotection in the acute period, methods for stimulating neuroregeneration in the subacute and recovery periods, and algorithms for personalized neurorehabilitation are considered. Particular attention is paid to the transition from empirical treatment to precision medicine in cerebrovascular pathology. CONCLUSION. Effective stroke treatment requires a transition from static unified protocols to dynamic personalized strategies. Only a systemic interdisciplinary approach is capable of reducing the burden of disability and improving the quality of life of patients. KEYWORDS: ischemic stroke, hemorrhagic stroke, patient stratification, neuroprotection, neuroregeneration, neurorehabilitation, neuroplasticity

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